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Mark Graban - Kaizen Presentation for Spain

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A presentation given, via recorded video, to a Lean Healthcare conference in Spain. See more information: http://www.leanauren.com/p/material-de-las-ii-jornadas-lean.html

A presentation given, via recorded video, to a Lean Healthcare conference in Spain. See more information: http://www.leanauren.com/p/material-de-las-ii-jornadas-lean.html

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  • Aging population (more demand, fewer workers), outrageously high costs (highest in the world by far) and poor quality (200,000 a year dying from infections and preventable errors). Uncertainty of what’s called the Patient Protection and Affordable Care Act (ObamaCare) – payments to hospitals are being cut… so many hospitals are laying off people.
  • Michel – it’s a short-term fix, but not a good fix
  • Staff morale  patient sat and outcomes
  • So where is all of the improvement?He called these “self-development and the pursuit of completeness are “familiar themes in medical instruction and history.” Bad apples instead of improving the processNeed to lead people toward solutionsShift away from finger pointing, name blame and shame
  • The 2nd one is from Australia
  • What does THIS have to do with THIS? What if…. the story of the consultant thrown out of a hospital for suggesting a moving assembly line.
  • This isn’t about tools – it’s about defining an ideal condition and working tirelessly to close the gap between current state (ACCURATE version) and the ideal state. Can we challenge assumptions? Test – first day on your job--- ask why something is done or why can’t we do it a better way? How does the organization respond? Start from need…
  • Guideline = 120 min “door- to-balloon” – 70% success“Did not have a clear, standardized response to heart attacks.”Now 100% success against 90 minute targetFocus on the patient as customerRespect the patient’s timeIdentify systemic causes of patient waitingStandardized workVisual managementStaffing levelsScheduling practicesLook across the entire “value stream”Minimize delays from handoffs
  • Cost per case actually DECREASED compared to the 2006 baseline. Sometimes you
  • One dysfunction is thinking kaizen (or improvement) is about episodic events
  • Need ALL of these steps
  • Suggestion boxes are well intended… perhaps. I’ll give them that much credit. But they seem like they don’t usually work. It’s not the fault of the box… it’s how they are managed. What are the two common features of these boxes, and more you can buy online? The lock… and their opaqueness.
  • David Mann
  • They have 100 idea boards
  • Berwick – stop looking for bad apples
  • Intermountain has similar data
  • 36% 53% 75% of departments had at least ONE person participate in Kaizen
  • If you include POTENTIAL SAVINGS – this number was $3M in 2010. Keep in mind they do NOT add up the financial impact of everything…
  • CALL TO ACTION: GO BACK AND DO ONE KAIZEN WHEN BACK TO WORK

Transcript

  • 1. The Present and Future of Lean Healthcare Mark Graban Jornadas Lean Healthcare en a September 20, 2012© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 2. Why Lean for Healthcare? No waiting No waste Zero harm Source: an NHS hospital, UK© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 3. Hospital Layoffs & Cost Cutting© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 4. “No Layoffs Due to Lean”© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 5. Layoffs Aren’t a Long-Term Fix • "After a year or so, the employee count is back up and the savings evaporate.” • "There has to be a better, longer lasting and less traumatic way to deal with such fiscal situations." Gary J. Passama, CEO NorthBay Healthcare (Fairfield, CA)© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 6. TPS: “Equally Important Pillars” Continuous Respect Improvement For People© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 7. Kaizen is for Everyone! “… emphasizes morale- boosting benefits and positive employee participation over the economic and financial incentives…” - Masaaki Imai© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 8. Dr. Berwick’s Call for Kaizen (1989) – Kaizen = “the continuous search for opportunities for all processes to get better” • Dr. Donald Berwick – Founder, Institute for Healthcare Improvement – Former Administrator, Medicare and Medicaid (CMS) Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New England Journal of Medicine, 1989 May 25;320(21):1424-5.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 9. Easier to Say Than to Do© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 10. Early Collaborations© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 11. 11© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 12. 5S A3 Kaizen VSM Std Work Kanban 12© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 13. 5S A3 Kaizen Kanban Std Work VSM Management System Philosophy Culture Thinking Mindsets 13© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 14. St. Elisabeth Hospital: The Netherlands Dr. Jacob Caron, Orthopedic Surgeon Chairman of the medical staff© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 15. • 90% reduction in CR-BSI in MICU and Oncology • Saved $1.7M • Saved 17 days L.O.S. per case Source: Dr. Richard Shannon© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 16. Improving Radiology /MRI Access Time 14 12 Weeks Waiting Time 10 8 6 4 2 0© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 17. ThedaCare “Door to Balloon” Time 100 90 91 80 70 65 60 50 52 40 37 37 45 30 20 10 0 2005 2006 2007 2008 2009 2010© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 18. ThedaCare’s Collaborative Care Med Rec Errors per Chart Patient Satisfaction1.2 100% 1 80%0.8 60%0.6 40%0.40.2 20% n/a 0 0% 2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative Pneumonia Bundle Compliance Cost per Case120% $8,000 $7,000100% $6,00080% $5,00060% $4,000 $3,00040% $2,00020% $1,000 0% $0 2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative Source: Health Affairs© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 19. Denver Health • “Denver Health Lean process has generated more than $135 million in financial benefit since 2006 (as of early 2012)” • Without those savings, Denver Health would "absolutely have had to cut jobs," CEO Patricia Gabow said.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 20. Kaizen = Change for the Better • ‘Kai’ means “change.” • ‘zen’ means “good.”© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 21. “What Sets Us Apart?” “Every Toyota team member is empowered with the ability to improve their work environment. This includes everything from quality and safety to the environment and productivity. Improvements and suggestions by team members are the cornerstone of Toyotas success.”© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 22. Different Levels of Kaizen Very few Large issues System Kaizen Six Few Sigma Medium issues Lean Event Many Small issues Daily Kaizen Adapted from: “The Toyota Way Fieldbook,” Liker and Meier© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 23. “Quick and Easy” Kaizen Find 1. Find 2. Discuss Discuss 3. Implement Implement 4. Document 5. Share Document Share© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 24. “Bubbles for Babies” Example© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 25. © 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 26. Kaizen: Real, Daily, Visual (Visual Idea Board)© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Children’s Medical Center Dallas (Lab)
  • 27. Completed “Idea Card”© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 28. Kaizen: Real, Daily, Visual (Electronic - KaiNexus)© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 29. Kaizen as a Way of Thinking Greg Jacobson, MD CEO & Co-Founder, KaiNexus© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 30. Kaizen Principles • Continually improve, with no idea being too small Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 31. Kaizen Principles • A major source of quality defects is problems in the process Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 32. Kaizen Principles • Focus change on common sense, low-cost, and low-risk improvements, not major innovations Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 33. Kaizen Principles • All ideas are addressed and responded to in some way Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 34. Kaizen Principles • Empower the worker to enact change Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 35. Kaizen Principles • Collect, verify, and analyze data to enact change Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 36. Before / After Data from CMC Lab Before Lean 12 Months After Starting Lean 3. I have the opportunity to do what I do best every day. 3.11 3.92 8. I feel free to make suggestions for improvement. 2.84 3.48 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to work. 2.51 3.43 18. I would recommend my work area as a good place to work to others. 2.38 3.46 Grand Average 2.96 3.69© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
  • 37. KaiNexus Data / Charts© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Whitepaper: http://bit.ly/KaiNexus
  • 38. Franciscan Participation 100% 90% 80% 70% 60% 56% 50% 46% 40% 30% 20% 10% 0% 2011 Since 2007© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
  • 39. # of Recorded Kaizens 4,500 4,225 3,951 4,000 3,500 3,000 2,822 2,500 2,046 2,000 1,500 1,000 500 281 - 2007 2008 2009 2010 2011© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
  • 40. Franciscan Savings Impact $2,000,000 $1,738,161 EMR $1,500,000 $1,000,000 $887,491 $925,518 $667,238 $500,000 $190,000 $- 2007 2008 2009 2010 2011© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
  • 41. Q&A / Contact Info • Email: mark@LeanBlog.org • Blog: www.LeanBlog.org • Startup: www.KaiNexus.com • Twitter: www.twitter.com/MarkGraban • Books: – www.LeanHospitalsBook.com – www.HCkaizen.com www.leanblog.org© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.